Plum Health Blog
What to Know About Monkeypox in Detroit
How to get the Monkeypox vaccine in Detroit
At Plum Health, we've had a lot of questions about Monkeypox from our patients and from the community.
If you are at a higher risk or in a higher risk group, please reach out to the City of Detroit Health Department or the Wayne County Health Department. or the Oakland County Health Department to get the two dose Monkeypox vaccine series.
We've had a few of our patients with potential exposures/higher risk get the vaccine via the Detroit Health Department. Usually, there's a pre-vaccination phone call and then they will schedule you for the two dose series. Here’s the contact info for the Detroit Health Department:
Detroit Health Department, 100 Mack Ave, Detroit, MI 48201 | (313) 876-4000
Here’s what the City of Detroit has written on their website:
The City of Detroit has begun providing doses of the Jynneos vaccines to Detroiters who have been exposed to the Monkeypox virus or who suspect they have been exposed, made available through the Michigan Department of Health and Human Services (MDHHS).
Background Information on Monkeypox
Monkeypox was first seen in 1958 in monkeys kept for research.
The first human case of monkeypox was recorded in 1970.
Prior to the 2022 outbreak, monkeypox had been reported in several central and western African countries.
Select cases have also been seen over the years in other countries due to international travel.
Now, in a world already changed by Covid-19 pandemic, we are seeing this worrisome visitor in our backyard. So, it’s best to get to know what monkeypox is, even if it isn’t here to stay.
A person infected with monkeypox will most likely have a mix of some of the following: fever, headache, muscle ache, chills, exhaustion, sore throat, cough, and/or nasal congestion.
Monkeypox also often presents with a rash that may be located on or near the genitals or anus but could also be on other areas like the hands, feet, chest, face, or mouth.
This rash can look like pimples or blisters and may be painful or itchy. It also goes through several stages, including forming a scab, before ultimately healing.
Monkeypox spreads through close contact and touch. This includes direct contact with a rash, scab, saliva, and/or bodily fluids of someone infected with monkeypox. Touching surfaces, clothes, or any fabrics used by someone with monkeypox can also lead to spread.
Sexual contact with someone who has monkeypox is a major source of spread, and pregnant mothers with monkeypox can spread the virus to their fetus through the placenta.
According to the CDC there are no treatments specifically for monkeypox virus infections. However, monkeypox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections.
Antivirals, such as tecovirimat, may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems.
In Michigan, as of August 4th, there were a total of 71 cases that have been reported. The City of Detroit has had the most outbreaks (19 cases), followed by Oakland County (13 cases) and Macomb County (10 cases). The rest of Wayne County comes in with 9 additional cases.
If you find yourself experiencing any of the symptoms of monkeypox that we have reviewed above, please contact your primary care provider and make an appointment to get tested.
Rest assured that your doctors and healthcare teams across the nation will continue to be diligent as we get more information. Research is ongoing regarding modes of spread and additional treatments. We will continue to serve you with up to date, well-informed guidelines.
Resources:
Plum Health Featured on Fox 2 News Detroit for Lowering the Cost of Insulin
Plum Health Featured on Fox 2 News Detroit for Lowering the Cost of Insulin
Yesterday, Plum Health DPC was featured on Fox 2 News Detroit for lowering the cost of insulin in Detroit and beyond.
MANAGING DIABETES IN DETROIT
Diabetes care can be difficult and expensive, especially if you’re uninsured. If you’re uninsured and trying to access diabetes care, patients can face the following costs:
$150 for a primary care visit
$150 to check hemoglobin a1c
$150 to check blood sugar via a comprehensive metabolic panel
$300 for insulin at the pharmacy
$10 for Metformin (Glucophage) at the pharmacy
At our Plum Health office, we dramatically lower the cost of these vital services to help our diabetic patients manage their blood sugar.
$55 to $75 monthly for as many primary care visits as it takes to manage your diabetes
$6 to check hemoglobin a1c
$6 to check blood sugar via a comprehensive metabolic panel
$0 for insulin at our Plum Health clinic as we get several free samples from industry
$0.30 to $0.60 for Metformin (Glucophage) at our Plum Health clinic
What makes this pricing difference even more important is that folks with diabetes need to check their hemoglobin a1c every 3 to 6 months to ensure that they are managing their diabetes effectively.
Dr. Paul Thomas of Plum Health DPC being interviewed by Fox 2 News about the high cost of insulin in Detroit and beyond. People routinely pay $125 for 1 pen of long-acting insulin like Tresiba. At our Plum Health DPC office, we are able to get free samples so that the cost is $0 for our members at Plum Health. Our mission is to make health care affordable and accessible, and lowering the cost of insulin is just one way that we achieve that mission.
Here’s our social media post about Insulin Costs in Detroit:
These insulin pens are $125 a piece at your local pharmacy. 🤑 💰
They should be capped at $35 a piece, but that protection was removed by Congress this week. 🤯😭🤢🤮
Fortunately, we get free samples from industry to help our patients at Plum Health DPC ✅
Tune in to Fox 2 News at 6 pm with Veronica Meadows as we talk about what’s broken in our healthcare system and what we’re doing to fix it 💯
#PlumHealth #DirectPrimaryCare #FamilyMedicine #insulin #drugprices #healthcare
Here’s what Fox 2 News Detroit wrote on their webpage about the story:
FOX 2 - For those who have diabetes, many know the struggle of paying for insulin.
"This can be $125 per pen at the pharmacy," said Dr. Paul Thomas. "In the United States there’s seven million people who need to take insulin and 25 percent of those cannot afford the insulin, they need to manage their diabetes."
For Raphael Wright, that stress hits close to home. A Detroit entrepreneur — Wright says at first he didn't have health insurance. He says his out-of-pocket cost for insulin used to be around $300 a month.
"It was a punch in the gut, I did not feel good," he said. "I am on the fringe because now I'm worried about getting my lights cut out. You need electricity to keep insulin cold."
Senator Debbie Stabenow (D) says starting in January the inflation reduction act will help more than three million in the US afford insulin.
"If you receive your health care through Medicare your insulin medicine will be capped your cost at $35 a month," she said.
But Senate Republicans stripped a provision that would have capped the price of insulin in the private marketplace. That cap also doesn't apply to people who don't have insurance.
"I think we should have a $35 cap for all Americans because there are a lot of people who are uninsured - they make too much money to qualify for Medicaid and not enough money to buy private insurance," said Dr. Thomas. "And even if you have private insurance your deductible could be $7,000."
Thomas is the founder of Plum Health Direct Primary Care in Corktown. He says thanks to free samples, his patients don't pay for insulin.
Thomas says his mission is to make healthcare accessible to everyone — especially diabetes patients. He says the results are devastating for those who are priced out of insulin.
"They’re going without, because of that high cost, and essentially this leads to really bad outcomes: Diabetic retinopathy which can cause blindness, diabetes does damage to your blood vessels, which can lead to early heart attacks and strokes," he said.
Thomas says diabetes is the number one cause of amputations and blindness in the United States. He says that is one more reason why insulin needs to be affordable for everyone.
Affordable and Accessible Health Care in Detroit
Affordable and Accessible Health Care in Detroit
At Plum Health, our goal is to make health care affordable and accessible in Detroit and beyond. We have a membership model for health care and our patients about $55 each month to $75 each month. Children pay $15 per month with an enrolled adult. When you’re a member of Plum Health, you can call, text, or email your doctor any time. You can come in for a visit anytime without a co-pay. Visits to Plum Health are included as a part of the membership. We also save people money on their medications and lab work. We buy medications at wholesale prices from AndaMeds, and then we sell these medications to our patients with little to no markup. This makes the medications that we dispense out of our practice much less expensive - sometimes 50% to 90% less expensive - than medications at the retail pharmacy.
Another way that we make health care more affordable and accessible is via house calls. As a physician, I make house calls for my patients. If our patients are in Detroit, we charge $100 per house call. If they live outside of the city, we may charge more to cover gas prices and time spent driving to the home that may be further away.
Dr. Paul Thomas with Plum Health DPC makes a house call for one of his members at Plum Health. Dr. Paul drove out to their home on the West Side of the City to make the house call.
Reproductive Health Care in Detroit Part Two
Reproductive Health Care in Detroit
In an ongoing conversation about reproductive health care, I will be giving some facts and figures about abortion in this blog post. Abortion is a flashpoint in our society; as always, I will be taking a measured, evidenced-based approach to this issue as I am a family medicine physician, and I rely on evidence to make clinical decisions.
The conversation here is adult/mature; the content here may be triggering for some readers. The descriptions of abortion here are not typically discussed in polite society. If you have concerns, read no further.
This week, I discussed much of the following information in the Daily Detroit podcast with Jer Staes. If you’d rather listen to this information, you can do so here:
You can listen to the podcast episode, here.
Abortion Rate in the United States
In 2020, the Census Bureau estimated that women made up about 50.7 percent of the population — some 167 million people. In the United States in 2020, the population of women ages 15-44 was 64,543,832.
In 2019, 629,898 legal induced abortions were reported to CDC from 49 reporting areas.
The majority of abortions in 2019 took place early in gestation:
92.7% of abortions were performed at ≤13 weeks’ gestation;
6.2% of abortions were performed at 14–20 weeks’ gestation
fewer than 1.0% of abortions were performed at ≥21 weeks’ gestation.
Early medical abortion is defined as the administration of medications(s) to induce an abortion at ≤9 completed weeks’ gestation, consistent with the current Food and Drug Administration labeling for mifepristone (implemented in 2016).
In 2019, 42.3% of all abortions were early medical abortions.
I think that knowing how many abortions take place per year is important. In short, there are 629,898 abortions for 64,543,832 women of childbearing age (15 to 44 years of age). That means that less than 1% of American women have an abortion each year (629,898 abortions / 64,543,832 women = 0.975% of women have an abortion every year.
And it’s important to know when these abortions take place during pregnancy. 92.7% of abortions take place at 13 weeks or less, or when the baby is the size of a lemon.
When is a Fetus Viable Outside of the Womb?
Doctors now consider 22 weeks the earliest gestational age when a baby is "viable," or able to survive outside the womb. But this is still extremely premature, and a baby born at this age will need a great deal of medical attention. Even if s/he survives, the risk of permanent disability is very high.
What are Common Scenarios When Abortion May Be Needed to Preserve the Health of the Mother or the Developing Fetus?
Ectopic pregnancy
Many people have heard of an ectopic pregnancy. An ectopic pregnancy is a pregnancy in which the fetus develops outside the uterus, typically in a fallopian tube. An ectopic pregnancy always ends in pregnancy loss. About 1 to 2% of all pregnancies in the United States are ectopic pregnancies.
The image on the left shows an embryo that is implanted correctly within the uterus. The right hand image demonstrates the various locations of an ectopic pregnancy. An ectopic pregnancy in the fallopian tube is called a tubal pregnancy, and can result in severe pain and damage to the fallopian tube.
Attribution: By BruceBlaus - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44897672
An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection.
Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. In these procedure, a small incision is made in the abdomen, near or in the navel. Next, your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the tubal area.
In a salpingostomy, the ectopic pregnancy is removed and the tube left to heal on its own. In a salpingectomy, the ectopic pregnancy and the tube are both removed.
Which procedure you have depends on the amount of bleeding and damage and whether the tube has ruptured. Also a factor is whether your other fallopian tube is normal or shows signs of prior damage.
In the context of an abortion ban, doctors may hesitate to intervene on behalf of a woman with an ectopic pregnancy. The doctor may have to contact the legal department at the hospital to ensure that they are not running afoul of the new rules and regulations. This hesitation and the time it takes to clear the legal department will likely result in more ruptured ectopic pregnancies, which will lead to damage to women’s reproductive organs, a decreased chance of healthy pregnancy in the future for these affected women, and potentially death for the mother in cases of sepsis or infected internal organs.
This is a real world consequence of this abortion ban, and this has already happened. Here’s a story from a nurse/health care worker on Instagram who relates how an ectopic pregnancy was not treated in a timely manner, and resulted in a rupture and then 600 mL of blood in the abdomen of the expectant mother, which came close to causing death for the mother.
A story posted on Instagram about a ruptured ectopic pregnancy and the real consequences for an expectant mother.
Here’s a similar story from Kaiser Health News about the importance of prompt care for ectopic pregnancy.
Incomplete Miscarriage
Miscarriage occurs in 8–15% of clinically recognized pregnancies and in ~30% of all pregnancies. Increasing maternal age is associated with an increasing risk of miscarriage. Many women may have a miscarriage and not even know it - they may experience a miscarriage as a heavy period a few weeks after their normal period. Other women may have a pregnancy, have a positive pregnancy test, and then miscarry a few weeks later.
These early miscarriages are often sad and painful, but don’t often require medical intervention as the mother’s lining of the uterus can slough off and expel the embryo/fetus/early pregnancy without retaining any tissue.
However, some pregnancies will experience a spontaneous abortion at 16 weeks or 18 weeks or 20 weeks, and the fetus/baby will be much larger. For whatever reason (usually a severe genetic problem) the baby will die in utero. This is not uncommon. The problem here is that some parts of conception (or body parts of the baby/fetus) can be retained, or some body parts can stay inside the uterus. If these products of conception are not removed, the uterus can be come infected and the mother could become septic and potentially die.
An incomplete abortion is the partial loss of the products of conception within the first 20 weeks. Incomplete abortion usually presents with moderate to severe vaginal bleeding, which may be associated with lower abdominal and/or pelvic pain. It is important to diagnose this early to make sure the patient expels all products of conception.
The overall incidence of spontaneous abortion is 10% to 15%. It is divided into early, <12 weeks, and late, >13 weeks.The causes of abortion are usually unknown but most commonly are attributed to fetal chromosomal abnormalities and the rest due to modifiable etiologies and risk factors. Treatment of incomplete abortion includes expectant, medical, and/or surgical treatment.Complications are rare but can be serious such as sepsis from the retained product, hemorrhagic shock, and uterine rupture. The prognosis for these patients is generally good with a proper workup, close obstetric follow-up, and patient education. [Source]
In patients with conception fragments at the cervical os, a clinician can remove the fragments with forceps to help initiate the process of hemostasis, facilitate uterine contractions, and decrease vagal stimulation. This will prevent cervical shock. In plain English, sometimes body parts of the fetus/baby get stuck in the mom’s uterus/cervix and they need to be removed by the OB/GYN with forceps. This is a heart-wrenching scenario, but again, doctors need to act fast to remove these retained products of conception, otherwise the mom can get a severe infection and die.
Patients with an incomplete abortion and retained products of conception commonly have one or more of the following signs: uterine bleeding, pelvic pain, fever and uterine tenderness. Patients with hemorrhagic shock have obvious blood loss and those with septic abortion have signs of sepsis.
Here’s a story that was circulating on social media over the weekend. A patient had a 16 week gestation fetus/baby in her uterus. Her water broke early, and the baby started to come out of the woman’s uterus, then cervix, then vagina, resulting with the fetus/baby’s foot resting outside of the vagina. In a case like this, the baby will die - it cannot be replaced into the uterus. However, this doctor is practicing in a state that has banned abortion. Because the baby’s heart is still beating, they have to wait until the baby dies before the retained products of conception/fetus/baby can be removed. This is harrowing.
In some cases, an early pregnancy at 8 or 10 or 12 weeks of gestation can die in the womb, but remain in the womb without clearing in a timely manner. This can lead to physical and emotional pain for the mom, and has a risk for infection/sepsis and death in the mother as well. In these cases, doctors can go in and remove the embryo/fetus with a vacuum suction or a dilation and curettage procedure, where the baby is scraped out of the uterus by the doctor.
To make this real, here’s a heartfelt story from NFL player Nick Sundberg about their family’s experience with needing an abortion (dilation and curettage) after his wife miscarried on two separate occasions.
In Vitro Fertilization (IVF)
Depending on the language and interpretation, a state law could curtail access to fertility treatments, and in some cases, make the practice of freezing or discarding unused embryos in In Vitro Fertilization illegal.
The language could affect fertility procedures in two ways.
The first impact could be on selective reduction, or multifetal reduction, the practice of reducing the number of fetuses in one pregnancy.
This procedure is not as common today but may occur if a woman undergoes hormone therapy, which could increase the number of eggs and result in triplets or quadruplets. In these cases, there is a chance the woman or embryos could be at greater risk of an unsuccessful pregnancy, which is why a fertility clinic may decide to reduce one or more of these fetuses. This could meet the definition of abortion in some states.
The more common practice, IVF, which results in half a million deliveries annually, is when eggs are extracted, fertilized and the embryos are formed in a petri dish outside of the body. The embryos are then genetically tested, and only the healthy ones are implanted, reducing the chances of selective reduction because they don’t have to implant as many at once. The unused embryos are either frozen and stored for later use, discarded during or after the process or donated for scientific research.
In some strict interpretations of the abortion ban, freezing or discarding embryos or donating embryos for scientific research could be criminalized.
Babies Without Developed Organs
Anencephaly is a severe congenital condition in which a large part of the skull is absent along with the cerebral hemispheres of the brain. Some women become pregnant and the baby develops without a brain.
Anencephaly is a rare type of neural tube defect that affects about 1 in 4,600 babies. There is no way to treat anencephaly. Babies born with this condition will die before or shortly after birth.
Spina bifida is a congenital defect of the spine in which part of the spinal cord and its meninges are exposed through a gap in the backbone. It often causes paralysis of the lower limbs, and sometimes mental handicap.
Cancer
Chemotherapeutic agents and radiation for cancer treatment can cause birth defects. Studies show there is a risk of birth defects when a woman becomes pregnant while getting or after receiving some types of chemotherapy, radiation therapy, and hormone therapy. In some cases, the risk can last for a long time, making getting pregnant a concern even years after treatment ends.
Rape or incest
Just 1% of women obtain an abortion because they became pregnant through rape, and less than 0.5% do so because of incest.
Does Banning Abortion reduce Abortion Rates?
According to data from the World Health Organization (WHO), the legality of abortion across the world actually has little to no effect on abortion rates throughout the world.
Legal or not, abortions can, will, and do take place.
The legality of abortion, however, does affect how safe those abortions are. Women who do not have access to a legal abortion frequently turn to illegal or "homemade" abortion options, which are typically much riskier, more dangerous, and less effective than legal options conducted by professional doctors in a clinical setting would be. (source)
Is abortion legal in Michigan right now?
Yes. Abortion is still legal in Michigan as long as the injunction is in place.
This is the latest email that I received from LARA or the Licensing and Regulatory Affairs of the State of Michigan:
On Friday, the U.S. Supreme Court overturned a woman’s constitutional right to abortion services. Under this decision, laws and court rulings in each state guide how health professionals provide abortions and abortion-related services. In Michigan, there is an injunction in place, based on a court order prior to Friday’s U.S. Supreme Court decision, that protects women seeking abortion services and the health care professionals assisting them. That order states, “Defendant [the Attorney General] and anyone acting under defendant’s control and supervision, see MCL 14.30, are hereby enjoined during the pendency of this action from enforcing MCL 750.14.” The order also provided that the Attorney General give immediate notice of the preliminary injunction to all state and local officials acting under her supervision. It is LARA’s position that abortion remains legal in Michigan because of the current injunction that prohibits enforcement of the 1931 law.
We understand that you may have some concerns about how continuing to provide medical and surgical services to women seeking abortion may impact your professional license. The Department of Licensing and Regulatory Affairs will not take any action against any health professionals for providing legal abortion services while the current injunction remains in place.
Thank you for your commitment to providing services to women in need and to all Michigan citizens. We will continue to update you as new information becomes available.
Bureau of Professional Licensing, Michigan Department of Licensing and Regulatory Affairs
Where can I Receive an abortion in Michigan right now?
To be clear, we do not perform abortions at our clinic. We do provide counseling, contraceptive care, pap smears, mammograms, women’s health care, and referrals for abortion when needed.
You can likely seek care from your OB/GYN at most major hospital systems or you can seek care from Planned Parenthood. If you are struggling to find options, please reach out to our office so that we can guide you through this difficult process.
How can we reduce abortion rates in michigan?
Abortion should be a last resort for women and for families. It is a difficult decision that can have long-lasting familial, physiological, and emotional effects. There are ways to reduce abortion rates if we want to and that looks like:
Access to free contraceptives
comprehensive sex education
universal health care
paid family leave
welfare funding
secure housing for all
closing the wage gap
funding education
According to the Colorado Department of Public Health and Environment:
The Colorado Family Planning Initiative drove a 50 percent reduction in teen births and abortions, avoided nearly $70 million in public assistance costs and empowered thousands of young women to make their own choices on when or whether to start a family.
A private donor’s investment in the state health department’s family planning program allowed us to train health care providers, support family planning clinics and remove the financial barriers to women choosing the safest, most effective form of contraception.
This initiative empowered thousands of Colorado women to choose when and whether to start a family.
Thanks in large part to the Colorado Family Planning Initiative:
Teen birth rate was nearly cut in half.
Teen abortion rate was nearly cut in half.
Births to women without a high school education fell 38 percent.
Second and higher order births to teens were cut by 57 percent.
Birth rate among young women ages 20-24 was cut by 20 percent.
Average age of first birth increased by 1.2 years among all women.
Rapid repeat births declined by 12 percent among all women.
Costs avoided: $66.1-$69.6 million.
In short, the above example from Colorado is an effective public health policy for reducing abortion. Banning abortion at a Federal level with little thought or care given to the nuances of pregnancy, ectopic pregnancy, miscarriages, etc… is an ineffective way to reduce abortion that will result in harm to the women of our country, their families, and our communities.
Thanks for reading,
-Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan
Reproductive Health Care in Detroit
Reproductive Health Care in Detroit
Abortion is a component of comprehensive medical care.
Healthcare decisions, including whether to have an abortion, are deeply personal and should be made between a patient and their physician.
The implications of today's Supreme Court decision are profound and will disrupt, and in some states, eliminate equitable and safe access to medical care for women and families in the United States.
This Supreme Court decision further threatens to exacerbate already unacceptably high maternal morbidity and mortality rates in the United States. (In 2018, there were 17 maternal deaths for every 100,000 live births in the U.S. — a ratio more than double that of most other high-income countries. In contrast, the maternal mortality ratio was 3 per 100,000 or fewer in the Netherlands, Norway, and New Zealand.)
In Michigan, abortion rights are in question due to a 1913 law that prohibits abortion unless the procedure is "necessary to preserve the life of such woman.” Michigan Attorney General Dana Nessel has made clear that she does not plan to charge anyone under the 1913 law, but County Prosecutors could potentially charge doctors and/or patients under the existing Michigan Law.
This is truly an unprecedented change that has created a lot of chaos and confusion for both patients and their doctors.
At Plum Health, we are committed to upholding the sanctity of the patient-physician relationship and to protecting women's reproductive rights by delivering evidence-based healthcare services.
Pragmatically, we will continue to offer oral contraceptive pills, birth control implants, IUDs, STD testing, Pap testing, HPV testing, beta HCG or pregnancy testing, Levonorgestrel (Plan B One Step or the morning after pill), referrals to doctors who prescribe mifepristone and misoprostol, and referrals to local abortion providers like Planned Parenthood and other board-certified obstetricians and gynecologists.
Additionally, we will continue to provide the high-quality psychiatric health care resources, referrals for behavioral health, a listening ear, and the emotional support that is needed as our patients and members of our community navigate these difficult decisions.
When women have the right to choose, they build healthier families and healthier communities.
The real-world impact of making abortion illegal
According to data from the World Health Organization (WHO), the legality of abortion across the world actually has little to no effect on abortion rates throughout the world.
Legal or not, abortions can, will, and do take place. The legality of abortion, however, does affect how safe those abortions are.
Women who do not have access to a legal abortion frequently turn to illegal or "homemade" abortion options, which are typically much riskier, more dangerous, and less effective than legal options conducted by professional doctors in a clinical setting would be.
Leading Causes of Death Among Children
Leading Causes of Death Among Children
I know that this isn’t the most uplifting topic, but it’s worth talking about. Children ages 1 to 19 years of age are most likely to die from Firearms, motor vehicle accidents, and drug overdoses and poisonings. What’s disconcerting is that the three leading causes of death among children are preventable.
We can prevent gun-related deaths, motor vehicle accidents, and drug overdoses/poisonings by change our local, State, and National policies to protect our most vulnerable members of society - children.
Here’s a graph from the New England Journal of Medicine that visualizes this information:
What you may notice is that firearm-related injury and death overtook motor vehicle crashes over the last few years. The authors of the NEJM article discuss this:
new data show a sharp 13.5% increase in the crude rate of firearm-related death from 2019 to 2020. This change was driven largely by firearm homicides, which saw a 33.4% increase in the crude rate from 2019 to 2020, whereas the crude rate of firearm suicides increased by 1.1%
This week, I took action on an issue that I care about, as I can see it every day. People in our neighborhood often drive 45 or 50 miles per hour in 35 mile per hour speed zone, and 35 miles per hour in a 25 mile per hour speed zone.
There’s compelling evidence/information from the AAA that examines your likelihood of being injured and dying when you’re a pedestrian who is hit by a motor vehicle. Here’s what they found:
Results show that the average risk of severe injury for a pedestrian struck by a vehicle reaches 10% at an impact speed of 16 mph, 25% at 23 mph, 50% at 31 mph, 75% at 39 mph, and 90% at 46 mph.
The average risk of death for a pedestrian reaches 10% at an impact speed of 23 mph, 25% at 32 mph, 50% at 42 mph, 75% at 50 mph, and 90% at 58 mph.
25 miles per hour to 35 miles per hour doesn’t sound like much, but your likelihood of injury moves from 25% around 25 mph to over 50% at 35 mph, and your likelihood of dying moves from 10% at 25 mph to over 25% at about 35 mph.
Because of this, I put up some signs in my neighborhood with the help of my United States Representative, Rashida Tlaib. It was affirming and empowering to talk about this and put up these signs, as people speeding through our neighborhood is an issue that is really bothersome.
Additionally, few cities in Metro Detroit design their communities for pedestrians first. The car/vehicle/automobile is prioritized. Often times, crosswalks are too wide to be safe for kids or elderly people to cross within the allotted time. Cross walks are often not present where pedestrians may want to cross. Sidewalks sometimes are not present where they should be.
All of this leads to people/pedestrians crossing where they can or walking in the street where there isn't a sidewalk, which can lead to accidents, injuries, and deaths.
Other communities in Metro Detroit do well with this, implementing road diets to reduce the number of traffic lanes, adding in bike lanes, slowing down speeds, adding curb bump outs to shorten the distance for pedestrians to cross the street.
If we want to become a region that attracts more people, we need to make our cities more live-able, more walkable, and safer for kids, bicyclists, older adults, and everyone.
All of that is to say, please drive safely, please drive at or under the speed LIMIT, and please look both ways for pedestrians, bikers, kids playing ball near the street, and kids in strollers. Thank you,
-Paul Thomas, MD
Daily Detroit Podcast hits 1,000 Episodes
Daily Detroit Podcast hits 1,000 Episodes
This week, the Daily Detroit Podcast hits 1,000 episodes! That’s a lot of content! The team of Jer Staes, Randy Walker, and Shianne Nocerini are diligent and talented, and they put together insightful, informative, and entertaining shows each week day.
Over the years, I’ve been a guest a handful of times to discuss medical care issues, mostly relating to coronavirus and the COVID 19 pandemic.
Episode from April 5th 2021 on the big coronavirus spike in the spring
Episode from April 15th 2018 about our Plum Health DPC practice
I’m happy to contribute and very proud of what this podcast has accomplished!
Plum Health DPC Featured in Upcoming Alive in Detroit Documentary
Plum Health DPC Featured in Upcoming Alive in Detroit Documentary
Alive in Detroit is a documentary put together by my friend Shiraz Ahmed. He has been acutely interested in health access in Detroit and beyond and our mission of making health care affordable and accessible in Detroit resonated with Shiraz. Shiraz included our work in a forthcoming documentary about health care in Detroit called Alive in Detroit. He’s raising money for the film right now on his Kickstarter campaign, so please contribute if you have the time and the means as this will be a timely and insightful documentary.
Shiraz was recently interviewed on WDET here in Detroit to explain more about the project. Here’s what WDET said:
“Alive in Detroit,” directed by filmmaker Shiraz Ahmed, is an upcoming feature-length documentary about the fight against chronic diseases such as cancer, heart disease and diabetes in the city. This story is a celebration of Detroiters and the work they do to heal their communities of illnesses while also providing them with protection and rights.
The film features a patient, a pastor and a physician whose stories inspire hope but also mask deeper inequities in the health care safety net. It’s a product of the city’s creative ecosystem, benefitting from programming by the Detroit Design Festival, the Freep Film Festival and Documenting Detroit.
“The pandemic’s really exposed all these cracks we have in our system,” he says. “I started this film before the pandemic, and then the pandemic just crystalized the themes I was looking at. It really gave me motivation – especially at a really depressing time when there was not a lot else to do to keep moving forward – because if we don’t address these inequities, another pandemic will happen and more people will keep dying.”
Dr. Paul Thomas Releases His New Book Dressing Well in Medicine
Dr. Paul Thomas Releases His New Book Dressing Well in Medicine
This month, Dr. Paul Thomas released his new book, Dressing Well in Medicine. It’s a short guide to help doctors look and feel their best, so that they can best serve their patients and the broader community.
The book cover for Dressing Well in Medicine, which is available on Amazon.
I wrote this book to help doctors and medical students to look and feel their best, so that they can uplift the doctor-patient relationship. For medical students, they are typically transitioning from college or undergraduate studies, to the professional environment of medical school and rotations through outpatient clinics and hospital settings. But, these medical students are not often given guidance on what to wear and what not to wear. There’s little to no discussion on what doctors wear and why it matters in the medical school curriculum!
My goal with this book is to help medical students look and feel mature and confident as they step into their new clinical roles and as they navigate professionalism and wearing professional attire as a physician. Ultimately, this will enhance students’ abilities to build trusting, healing relationships with their patients.
For practicing doctors, Dressing Well in Medicine serves as a reminder or a refresher on how to look and feel your best when taking care of patients, all while taking into account the latest evidence on this subject from peer-reviewed journals. Again, the goal is to foster trusting and healing relationships with doctors and their patients.
Recently, Dr. Thomas was interviewed by Drs. Melissa Cady and Kevin Cuccaro on their show The Changed Physician. The discussion was wide ranging and at some points, intense! Let’s face it - doctors don’t often discuss what doctors wear and why it matters, and there are so many challenging parts of physician attire and appearance that make for great discussion points, and sometimes, flash points. You can catch the full interview, here:
Finally, here’s a robust description of the Dressing Well in Medicine book:
Dressing Well in Medicine is a short guide for dressing well in medical school and beyond. You will need to look like a professional from the beginning of your medical school interview trail, to the whirlwind of clerkships and rotations, through your residency interviews and residency training, and eventually through your day-to-day clinical practice.
Dressing professionally is important because the trust and confidence of your patients depends in large part on your appearance, and professional attire greatly improves your appearance. A smartly-dressed, polished, and tasteful physician inspires confidence - the rumpled, disheveled, or schlubby doctor does not inspire that same confidence.
Therefore, I have written this book to give general guidelines for what to wear in the clinical setting and I believe that you will find it useful no matter where you are in your career.
As a medical student, there was no clear guidance on how to dress for a successful career in medicine. There’s no course in the medical school curriculum dedicated to appearance and demeanor. There’s no opportunity to discuss how our physical presentation as physicians can help us have better interactions with our patients or how our wardrobe choices can improve our chances of landing the residency program of our choice. There’s often not even a lecture on this topic.
I firmly believe that when we physicians dress intentionally, we can uplift the doctor-patient relationship and create the practice environments that enhance this sacred relationship at the level of the clinic, the hospital, and across the healthcare system.
I wanted to start a dialogue with aspiring doctors and practicing physicians about what we wear and why it matters. I truly believe that by dressing well in medicine, we can be our best selves as physicians, community leaders, and as leaders in the healthcare space.
Let this book serve as that missing piece of the curriculum, that crucial conversation on clothing choices and their impact on our patients, colleagues, and broader community.
Thank you for reading and watching!
-Dr. Paul Thomas with Plum Health DPC
Dr. Leslie Rabaut is a Family Medicine Doctor in Detroit Michigan
Dr. Leslie Rabaut is a Family Medicine Doctor in Detroit Michigan
Dr. Leslie Rabaut is a Family Medicine Doctor in Detroit Michigan and she is accepting new patients at our Plum Health DPC office in Corktown, at the corner of Michigan and Trumbull. Here’s her most recent review from one of our patients in our Plum Health practice:
I am fairly certain Dr. Leslie Rabaut is a literal genius. At the very least she is incredibly well-versed in medical knowledge and unbelievably sharp in her ability to recall unusual causation and find correlative patterns. She deserves an actual prize. She is "the Doctor's doctor". If you're smart and tired of poor medical care, or work in the field, pick her. Pick her brilliant brain.
To become a patient of Dr. Leslie Rabaut, you can enroll in our service, here.
Paul Thomas, MD - Recent Alumni Award Recipient from Wayne State University School of Medicine
Paul Thomas, MD - Recent Alumni Award Recipient from Wayne State University School of Medicine
In 2019, Dr. Paul Thomas received the Recent Alumni Award from Wayne State University School of Medicine. This is a prestigious award that is not given out every year. Here’s how it’s described by WSU SOM:
The Recent Alumni Award, established in 2003, is presented to an individual who received an M.D. degree from the WSU School of Medicine within the last 15 years and has demonstrated outstanding professional achievement, community contributions or service to Wayne State University School of Medicine.
Here’s a list of the previous Recent Alumni Award Winners at Wayne State University School of Medicine:
Plum Health DPC is a Family Medicine Practice in Detroit that is Accepting New Patients
Plum Health DPC is a family medicine practice in Detroit that is accepting new patients.
We have a family medicine clinic with three family medicine doctors and we are all accepting new patients into our practice. We see patients of all ages and stages and help our patients with a variety of medical concerns, like asthma, allergies, sleep apnea, depression, anxiety, diabetes, high blood pressure, hypertension, anemia, acid reflux, obesity, and so much more.
Médica Hispanohablante, Plum Health DPC en Detroit
Necesita ver a un doctor primario que hable español?
O no tiene seguro médico?
Tenemos muy buenas noticias! Nuestra doctora Leslie Rabaut, habla español y para verla usted no necesita tener seguro médico.
Le invitamos a formar parte de nuestra practica donde usted tendra accesibilidad a consultar su doctora la cual habla español, tendra descuentos en laboratorios y medicamentos y muchos beneficios mas.
Todo incluido bajo un pago mensual economico de entre $55 a $89 al mes.
Tiene preguntas? Le gustaria obtener mas información?
Llamenos al 313-444-5630 y con gusto le atenderemos.
Tambien puede visitar nuestro página web: www.PlumHealthDPC.com
Plum Health DPC
1620 Michigan Ave, Suite 125
Detroit, MI 48216
Se necesita una médica quien se habla español?
No tiene seguro médico?
Tenemos buenas noticias para Ud.
Dr. Rabaut es una generalista ubicada en clínica de Plum Health en Corktown Detroit.
Ella se habla español con fluidez y acepta pacientes sin seguro médico.
Se paga una carga cada mes para ser miembro en la clínica.
Para los de edad 18-39: $55 cada mes
Edad 40-64 $75/mes
Edad >65 $89/mes
Si quiere más información, que nos llame en 313-444-5630 o visite nuestro página web:
www.PlumHealthDPC.com
Plum Health DPC
1620 Michigan Ave, Suite 125
Detroit, MI 48216
Blood Lead Level Testing for Children and Adults in Detroit
Blood Lead Level Testing for Children and Adults in Detroit
If you live an older home in Detroit, it’s a good idea to have yourself and your child tested for blood lead levels.
In 1978, the federal government banned consumer uses of lead-based paint, but some states banned it even earlier. Lead paint is still present in millions of homes, sometimes under layers of newer paint. If the paint is in good shape, the lead paint is usually not a problem. If you live in an older home and you’ve had your home undergo renovations where lead dust may have been in the air, it’s reasonable to have yourself and your child tested for lead levels in the blood.
Generally speaking, it's recommended that all children be tested for high lead levels by ages 1 or 2, and children at higher risk for lead toxicity should get tested whenever there’s a suspicion for lead exposure.
All children covered by Medicaid are considered high risk for lead exposure (that’s why all children are tested at 12 and 24 mo).
In Michigan, deteriorated lead paint is the #1 source of lead exposure.
If a person has lead exposure during pregnancy or while breast feeding, lead can also enter their baby’s blood
Homes built before 1978 or having renovations, repair work, or remodeling in the last 12 months confers a higher risk of lead exposure.
Plum Health DPC is a Best of MichBusiness Award Winner
This month, Plum Health was named the Best Startup in Michigan by CORP! Magazine during their Best of MichBusiness Awards event. Here’s what they said about us:
Start-Up Businesses
One of the biggest issues during the ongoing pandemic has been access to affordable health care, something the folks at Plum Health Detroit know a little something about.
In 2021, Plum Health adapted by focusing on supporting physicians and making sure they had the tools, training, and time they needed to "deliver excellent care and service for our patients."
"Delivering excellent, comprehensive primary care services is challenging in a typical environment, but with the pandemic ongoing, we've increased our support of our doctors to ensure long-term sustainability of our practice," said Dr. Paul Thomas, Plum Health's founder. "At our clinic, we prioritize meeting the needs of our patients, while balancing family and home obligations for happy and healthy physicians. When doctors are happy and satisfied with a flexible work environment and schedule, they'll be able to help their patients to the best of their ability."
That attitude helped lead Plum Health to becoming the overall winner in the Start-Up Business category in the 2021 Best of MichBusiness Awards.
In 2021, Plum Health rolled out curb-side COVID testing and vaccination, helping thousands of Detroiters get vaccinated, either through the clinic or by educating them on nearby resources that they could utilize for vaccination and testing.
To read the full article, head to this link and navigate to pages 52/53 of the January/February issue of CORP! Magazine.
More from Best of MichBusiness Awards:
Thank you for making last week’s Best of MichBusiness Awards a wonderful experience. The community is buzzing around the phenomenal honorees and awards from the week. It was an honor to work with you and celebrate your success.
Here are a few follow up items regarding your honor:
Awards Presentation Link: https://vimeo.com/668363594/c0f05a81f1
Best of MichBusiness Program Book: CLICK HERE
The featured article in Corp! Magazine with the overall winners: January/February issue
Dr. Raquel Orlich is a Family Medicine Doctor in Detroit Michigan
Dr. Raquel Orlich is a Family Medicine Doctor in Detroit Michigan
Dr. Raquel Orlich is a family medicine doctor and she has been practicing with our clinic, Plum Health DPC, in Corktown Detroit for the past 2 years and 8 months. She provides excellent, compassionate care for our patients at Plum Health and delivers comprehensive care for all of her patients.
Dr. Raquel Orlich is Board Certified in Family Medicine and Board Certified in Obesity Medicine. She loves helping her patients with musculoskeletal issues via the use of Osteopathic Manual Medicine (OMM), she enjoys engaging in women’s health care issues, and she enjoys addressing overweight and obesity issues as she helps her patients lose weight and become healthier.
Further, Dr. Raquel Orlich’s patients love the care that she delivers. This is best captured by a recent Google review from one such patient:
By far the best in health care I've ever dealt with. I was only a patient here under a year, but I gleaned so much info and confidence in my health journey. I moved to another state and am constantly wishing I could just hop in to Plum! I saw Raquel Orlich specifically, and she was a joy as well as being supremely comfortable, knowledgeable and communicative. Every test was returned with detailed results so I was never once confused or doing my own research or guessing at how to correct the issue. She always heard me out and was willing to explore even if I was wrong. I was never brushed off and I usually left feeling confident. Chris was amazing and so welcoming as well and made all the labs a breeze. I'd honestly stand outside with a sandwich board on waiving cars into the parking lot like H&R block in tax season if they wanted me to. 🤣 They are so worth it.
Further, Dr. Orlich has been with us for 2 years and 8 months, so she knows many of the resources available to patients here in Detroit and beyond. This allows her to guide patients to the best care options and reach their optimal health.
Thank you Dr. Orlich for all that you do for our clinic and our patients!
The above photo was taken in March 2019 - Dr. Orlich was completing the last few months of her residency program and she was coming by to pick up a fresh new white coat and her new business cards. This was an exciting moment and it was so great to welcome her as part of our Plum Health team.
Dr. Leslie Rabaut is a Family Medicine Physician Accepting New Patients in Detroit Michigan
Dr. Leslie Rabaut is a Family Medicine Physician Accepting New Patients in Detroit Michigan
Dr. Leslie Rabaut is a Family Medicine Physician Accepting New Patients in Detroit Michigan - she is an excellent physician who delivers excellent care for her patients and the broader community. We are lucky to have her as a part of our service here at Plum Health DPC.
With that being said, she has about 261 patients at this time, and she has garnered that number of patients over the last 1 year. Dr. Rabaut started at our clinic on February 1st, 2021, and through the pandemic, she has gained 261 patients. She takes care of a diverse group of people from many different backgrounds.
Dr. Rabaut will likely cap at 400 to 500 patients so that she can maintain this high level of care, service, and excellence for her patients. Dr. Rabaut will likely reach a full panel in 6 months to 12 months from this time, so if you’re looking for an excellent direct primary care doctor, please sign up to be one of Dr. Rabaut’s patients sooner than later, before her panel is full.
Our patients love Dr. Rabaut and they have given her high praise on our Google Review site. Here’s the most recent review for Dr. Rabaut:
Ohhh, the healthcare system. What an interesting collection of institutions! I wish more places were like Plum Health though. For a couple years, I was stuck with an insurance company that didn't have great PCPs and then had some job changes, which basically made relying upon insurance a complicated process. I remembered Plum Health from Demo Day and decided to reach out.
Absolutely loved the attention that I received from Dr. Rabaut. After having an experience with a PCP who rushed through my appointments and didn't actually listen to what I was saying about my own body, my experience with Plum Health was a breath of fresh air.
Here’s another review for Dr. Rabaut:
I have been Dr. Rabaut's patient for about a year now, and I have to say that she is HANDS DOWN the best doctor I have had. I email her dumb (and not so dumb) questions all the time and she always emails me back right away. Even on a Saturday. She is approachable and honest. When she listens, she is actually listening. I will be lucky if I get to be under her care for a very long time.
And here’s another recent review for Dr. Leslie Rabaut:
I have never had a visit to the doctor like this before. I have always had terrible amxiety going to the doctors. Here I didn't have to wait at all to see the doctor. Dr. Leslie Raubart came in and talked with me for 45 minutes!! (At my last doctor I would be lucky if I got 10 mintues) She was amazing and you can tell she truly cares. She is very good at asking you the right questions and getting all the details. When my blood results came back, she emailed me a very detailed message explaining what supplements and a plan of action for the future. I am so glad to have found this.
In summary, Dr. Leslie Rabaut is an excellent family medicine physician and she is accepting new patients at our Plum Health DPC office in Detroit, Michigan.
How to Deal with Neck Pain in Detroit Michigan
How to Deal with Neck Pain in Detroit Michigan
A common musculoskeletal issue is “text neck” where we look down at our devices like tablets, phones, and computers throughout the day. This can stretch the muscles at the base of your skull and cause those muscles to spasm when they get over stretched.
My favorite modality for treating text neck is about repositioning our bodies and stretching our neck muscles gently twice daily. These twice daily stretches will keep your neck muscles loose and diminish spasming over time. The more consistent you can be with stretching, the better your improvement.
If your symptoms persist - if you have continued neck muscle spasming, you can try medications like NSAIDS or muscle relaxants. Of course, talk to your doctor before you use these medications to make sure that they don’t cause any stomach irritation or kidney damage.
It would be reasonable to try Ibuprofen 600 mg if you experience neck muscle spasms that cannot be controlled or that cause pain. Ibuprofen is an NSAID.
An alternative would be to take Flexeril (Cyclobenzaprine) 10 mg 1 hour prior to bed time - this is a prescription medication so please consult with your physician before using a medication like this. Cyclobenzaprine is a muscle relaxant and patients get relief when they use this medication as it relaxes skeletal muscles. But it cannot be taken within 8 hours of driving or operating heavy machinery as it causes drowsiness in some patients, so we have our patients take the medication 1 hour prior to bedtime.
Another alternative to neck pain treatment is osteopathic manual therapy (OMT) that would be given by an osteopathic doctor (a D.O.). These treatments take 15 minutes to 30 minutes and they can focus on relaxing/manually stretching the muscles in the neck. Our physician at our office, Dr. Raquel Orlich specializes in this type of therapy.
A combination of the above modalities would reduce the muscle spasms that you’re experiencing in your neck.
Thanks for reading and watching,
-Dr. Paul Thomas
How we manage Urinary Tract Infections at Plum Health DPC in Detroit
How we manage Urinary Tract Infections at Plum Health DPC in Detroit
At Plum Health DPC in Detroit Michigan, we help our patients with several different medical problems, from high blood pressure, to diabetes, weight loss, and urinary tract infections and so many more.
At our office, it costs about $3 to run a urinalysis and about $6 for a urine culture. If you’d like to test for chlamydia and gonorrhea, it costs about $23. We usually test for this as there can be overlap in symptoms for a urinary tract infection and a sexually transmitted infection. We also run a pregnancy test for free, to make sure that it’s safe to give antibiotics.
As for treatment of urinary tract infections, we typically use antibiotics like Bactrim (trimethoprim/sulfamethoxazole) or Nitrofurantoin. The Bactrim is about $0.86 (86 cents) for a course of therapy and the Nitrofurantoin is about $2 for a course of treatment.
Thanks for reading and watching, and have a wonderful day.
-Dr. Paul Thomas with Plum Health DPC
Pricing Changes for 2022
Plum Pack!
At this time, we are raising our prices for most of our membership tiers. These pricing changes will go into effect on March 1st, 2022. Our new pricing sets are as follows:
Children, 0 to 17 years of age: $15 per month (an increase of $5/month)
Adults, 18 to 39 years of age: $55 per month (an increase of $6/month)
Older Adults 40 to 64 years of age: $75 per month (an increase of $6/month)
Senior Adults 65 and up: $89 per month (no change)
We had to make this difficult decision because of several factors including the increasing complexity of the services that we deliver at our clinic and the rising costs of necessary supplies and equipment for our business.
For example, pre-pandemic, a box of 200 latex gloves would cost $9.95, now it costs $24.95 for that same box of gloves.
We remain committed to delivering affordable and accessible health care services. These price increases will allow us to continue to deliver excellent care and service.
We appreciate you for being a part of the service, and our unending thanks for being a part of the Plum Pack.
Sincerely,
Drs. Paul Thomas, MD Raquel Orlich, DO and Leslie Rabaut DO
Should you have questions, do not hesitate to call our office at 313.444.5630)